腹膜透析相关真菌性腹膜炎的危险因素及结局分析  

作　　者：孙滋蔚 王夏颖 朱星瑜[1] 童孟立[1] 

机构地区：[1]浙江中医药大学附属杭州市中医院,310007

出　　处：《浙江临床医学》2024年第1期61-63,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省中医药科技计划项目(2023ZL098)。

摘　　要：目的探讨腹膜透析(PD)相关性真菌性腹膜炎(FP)的危险因素及结局。方法回顾性分析2017年1月至2022年12月19例FP患者的临床资料,按1:5抽取同期诊断为细菌性腹膜炎的95例患者为对照组,分析FP的结局及其危险因素。结果19例FP中共检出真菌22株,包括白假丝酵母菌7株,光滑念珠菌5株,近平滑念珠菌4株,热带念珠菌2株,无名念珠菌1例,弯孢菌1株,黄曲霉菌1株,罗伦特隐球菌1株。与对照组比较,FP组既往抗生素使用率(P<0.001)和腹膜炎发生率(P=0.015)更高,腹透时间(P=0.012)更长,血清白蛋白(Alb)更低(P=0.006),高敏C-反应蛋白(HsCRP)(P=0.034)水平更高。转血透率(P<0.001)和自动出院率(P=0.023)更高。Logistic回归分析显示,既往有腹膜炎病史、1个月内使用抗生素、腹透时间长是FP的危险因素。Kaplan-Meier生存曲线分析显示两组生存率差异无统计学意义(P>0.05)。结论既往使用抗生素、PDAP病史、长透析龄是FP的危险因素。FP是腹膜透析的严重并发症,是导致腹透患者转血透和3个月内死亡的主要原因,应警惕过度抗生素的使用,确诊后尽早抗真菌治疗及拔管。Objective To investigate risk factors and outcomes of peritoneal dialysis(PD)associated fungal peritonitis(FP).Methods This single-center study retrospectively reviewed all FP episodes diagnosed from January 2017 to December 2022 in the PD center of Hangzhou Hospital of Traditional Chinese Medicine.And detailed data related to peritonitis episodes were recorded after matching 1:5 with patients diagnosed with bacterial peritonitis during the same period.Results A total of 22 fungal strains were detected in 19 cases of FP,including 7 strains of Pseudomonas albicans,5 strains of Candida smoothus,4 strains of Candida subsmoothus,and 2 strains of Candida tropicalis,One case of Candida inangulate,one curum,one Aspergillus flavus and one Cryptococcus lorrente.Compared with the non-FP group,the FP group had higher rates of previous antibiotic use(P<0.001)and peritonitis(P=0.015),longer duration of PD(P=0.012),lower plasma albumin(Alb)(P=0.006),and higher levels of high-sensitivity C-reactive protein(Hs-CRP)(P=0.034).The rate of conversion to hemodialysis(P<0.001)and automatic discharge(P=0.023)were higher.Kaplan-Meier survival curve analysis suggested no significant difference in survival rates between the two groups.Conclusion Previous antibiotic use,previous history of peritoneal dialysis associated peritonitis(PDAP),and long dialysis age are risk factors for FP.FP is a serious complication of PD and a major cause of conversion to hemodialysis and death within 3 months in patients on PD,and excessive antibiotic use should be guarded against.Following a confirmed diagnosis,initiate antifungal treatment as early as possible and consider early extubation.

关 键 词：腹膜透析 真菌性腹膜炎 危险因素 

分 类 号：R459.5[医药卫生—治疗学] R572.2[医药卫生—临床医学]